| NPI | 1780099820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71005032A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28159100A) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2017-04-19 |