| NPI | 1801365598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71008844A) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: IN 28177212a) |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2019-03-08 |