| NPI | 1841739380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71006956A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28207536a) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2021-07-22 |