| NPI | 1831410703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71003284A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28161093A) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2021-01-12 |