| NPI | 1730840745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71012218A) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: IN 28225235A) |
| Enumeration Date | 2022-01-03 |
| Last Update Date | 2022-02-10 |