| NPI | 1720447733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71006374A) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: IN 28202586A) |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2020-03-11 |