| NPI | 1437625803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71008548A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28150165A) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2019-07-22 |