| NPI | 1891346763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 28216219A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71009383A) |
| 163W00000X Registered Nurse (Licence: IN 28216219A) | |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2021-02-17 |