| NPI | 1326758889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71014499A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71014499B) |
| Enumeration Date | 2022-11-24 |
| Last Update Date | 2024-02-07 |