| NPI | 1639030455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71017442A) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71017442A) |
| Enumeration Date | 2025-11-20 |
| Last Update Date | 2026-02-25 |