| NPI | 1902594070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71014034A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28258550A) |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2023-08-03 |