| NPI | 1689294357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 28163222A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IN 71009965A) |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2020-09-15 |