| NPI | 1619473873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71008075A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 21608) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 21608) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: SC 21608) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71008075A) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: SC 21608) | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2023-12-05 |