| NPI | 1619978178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71000812A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TN APN0000012531) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2022-10-20 |