| NPI | 1457976615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 28174509A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71010247A) |
| Enumeration Date | 2020-06-13 |
| Last Update Date | 2022-05-03 |