| NPI | 1891688701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 28247807A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71017145A) |
| Enumeration Date | 2025-05-30 |
| Last Update Date | 2025-09-22 |