| NPI | 1669191292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71014417A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28245747A) |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2024-02-01 |