| NPI | 1710552070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71011193A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28156764A) |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2021-12-04 |