| NPI | 1659625275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 16733) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IN 71004227A) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2015-07-21 |