| NPI | 1457018160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 28209761A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN F11210466) |
| Enumeration Date | 2021-11-17 |
| Last Update Date | 2024-06-03 |