| NPI | 1922333194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71003104A) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 28139511A) |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2014-09-02 |