| NPI | 1780145904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71008913A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28235051A) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2022-12-20 |