| NPI | 1417614678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71012274A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28205845A) |
| 363L00000X Nurse Practitioner (Licence: IN 71012274A) | |
| Enumeration Date | 2021-11-23 |
| Last Update Date | 2023-08-31 |