| NPI | 1609473297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71011246A) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: IN 28203770A) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2021-11-12 |