| NPI | 1386366060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71013460A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28249805a) |
| 163W00000X Registered Nurse (Licence: IN 28249805a) | |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2023-02-03 |