| NPI | 1780070755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 28164929A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 71005447A) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2023-03-07 |