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 |