| NPI | 1356774202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP017530) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71004563B) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71004563A) | |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2022-04-24 |