| NPI | 1528555216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 28207276A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28207276A) |
| 363LF0000X Nurse Practitioner Family (Licence: KY 3015193) | |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2020-10-06 |