| NPI | 1457728719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71005687A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71005687B) |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2015-08-21 |