| NPI | 1780243972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71009013A) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: IN 71009013A) |
| 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: IN 28196594A) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2019-07-03 |