| NPI | 1679160402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71010775A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28208886A) |
| 363L00000X Nurse Practitioner (Licence: IN 71010775A) | |
| Enumeration Date | 2020-12-28 |
| Last Update Date | 2023-08-03 |