| NPI | 1790479194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71014035A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN F05230867) |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2025-08-21 |