| NPI | 1417424144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71008664A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28201828A) |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2024-09-26 |