| NPI | 1497414684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71012778A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28199770A) |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2023-02-06 |