| NPI | 1568054922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71010962A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28215765A) |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2021-03-31 |