| NPI | 1598545360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71016312A) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: IN 71016312A) |
| Enumeration Date | 2023-09-29 |
| Last Update Date | 2026-07-20 |