| NPI | 1598251175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71009487B) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5010695) |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2019-11-19 |