| NPI | 1780758367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ AP 1956) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ RN- 070415) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2014-01-22 |