| NPI | 1912612649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71014380A) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: IN 28199038A) |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2023-11-13 |