| NPI | 1336814466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71011518A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28228600A) |
| Enumeration Date | 2021-08-11 |
| Last Update Date | 2021-09-17 |