| NPI | 1386280253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71010547A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209021656) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2023-03-01 |