| NPI | 1730963133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IN 71015759A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28274312A) |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2024-11-04 |