| NPI | 1699171215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71006259A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60520310) |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2025-06-02 |