| NPI | 1407347750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71009841A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MT 130422) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2021-09-21 |