| NPI | 1790140390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71007963A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WA AP-60600744) |
| 363LF0000X Nurse Practitioner Family (Licence: NM CNP-02800) | |
| Enumeration Date | 2015-12-24 |
| Last Update Date | 2022-07-21 |