| NPI | 1720195340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71000570A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71000570A) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2021-01-26 |