| NPI | 1417525759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71013783A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95037495) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2025-12-24 |