| NPI | 1639192438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71002217A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 71002217A) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2026-06-03 |