| NPI | 1912570292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71013448A) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: IN 71011354A) |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2023-03-10 |