| NPI | 1669621066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71002752A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28150342) |
| 363L00000X Nurse Practitioner (Licence: IN 71002752A) | |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2023-08-02 |