| NPI | 1659158780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71014442A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28228935A) |
| Enumeration Date | 2023-09-12 |
| Last Update Date | 2023-10-23 |