| NPI | 1760001200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71009970A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704339651) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2023-05-02 |