| NPI | 1497273031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71007313A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28200539A) |
| Enumeration Date | 2017-09-04 |
| Last Update Date | 2021-01-22 |