| NPI | 1801416649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71010061A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IN 28220354A) |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2020-07-16 |