| NPI | 1598320590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71009118A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71009118a) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2025-10-09 |