| NPI | 1366094849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71013246A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3013498) |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2023-09-14 |