| NPI | 1922554831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 28197039A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MT 115857) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2019-08-22 |