| NPI | 1386793008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71010470A) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: KY 3599P) |
| 363L00000X Nurse Practitioner (Licence: KY 3599P) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2023-05-15 |