| NPI | 1346996295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IN 28251946A) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: IN 28251946A) |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2022-08-24 |