| NPI | 1366193377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71012167A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28234112A) |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2022-10-15 |