| NPI | 1356776918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 741004600A) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: IN 28161345A) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 741004600A) | |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2020-10-21 |