| NPI | 1346745619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71007934A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28209197A) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2019-07-24 |