| NPI | 1811375207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71005723A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28157005A) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2015-09-14 |