| NPI | 1659627891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71004216A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28158483A) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2020-11-20 |