| NPI | 1407120082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71011632A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 20489) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 80125) | |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2024-07-27 |