| NPI | 1689982803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71004455A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28204676A) |
| 163W00000X Registered Nurse (Licence: NY 578768-1) | |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2018-09-18 |