| NPI | 1801362199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71010342A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MT 132522) |
| Enumeration Date | 2018-10-15 |
| Last Update Date | 2020-09-29 |