| NPI | 1457766594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71005088A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28184708A) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2014-09-02 |