| NPI | 1629856190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71015663A) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: IN 28259521A) |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2025-01-01 |