NPI | 1649694217 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71004801A) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008674) |
Enumeration Date | 2014-02-18 |
Last Update Date | 2022-08-04 |