| NPI | 1568050136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71010741A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71010741A) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71010741A) | |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2025-09-16 |