| NPI | 1558189639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71016734A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28266711C) |
| Enumeration Date | 2024-09-28 |
| Last Update Date | 2026-03-09 |