| NPI | 1861134314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71012508A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28251083A) |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2022-04-25 |