| NPI | 1609590389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 28207179C) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 28207179C) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 28207179C) | |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2022-12-02 |