| NPI | 1487188983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71007079A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28222652A) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2017-05-08 |