| NPI | 1356961809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: IN 28162730A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28162730A) |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2020-06-09 |