| NPI | 1346686235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: IN 71004543A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28174732A) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2021-03-01 |