| NPI | 1508411315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71009590A) |
| Additional Taxonomies | 363LS0200X Nurse Practitioner, School (Licence: IN 28163831A) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2020-09-10 |