| NPI | 1447779160 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71007523A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28198765A) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2020-12-18 |