| NPI | 1558792382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71004760A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28169639A) |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2023-05-01 |