| NPI | 1801673520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 28220903A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28220903A) |
| 363LF0000X Nurse Practitioner Family (Licence: IN 71014394A) | |
| Enumeration Date | 2023-09-14 |
| Last Update Date | 2024-04-09 |