| NPI | 1356893929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71006760A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28231559A) |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2020-11-30 |