| NPI | 1669311932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71018146A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28282019A) |
| Enumeration Date | 2026-03-25 |
| Last Update Date | 2026-08-04 |