| NPI | 1508475526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IN 28167819A) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71010188A) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2021-12-09 |