| NPI | 1689015927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND R50536) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71004655A) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2023-12-20 |