| NPI | 1811602543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71014038A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28183366A) |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2023-07-14 |