| NPI | 1790782845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71001760A) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IN 71001760A) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2022-07-21 |