| NPI | 1679687115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71002273A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28116994A) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2023-11-27 |