| NPI | 1760037394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71009501A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 01076682A) |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2019-10-23 |