NPI | 1780192500 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5010176) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71016798A) |
Enumeration Date | 2018-01-15 |
Last Update Date | 2025-09-15 |