| NPI | 1447626981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71006968A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 344722) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2024-09-13 |