| NPI | 1568934271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IN 71008806A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28202093A) |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2022-07-05 |