| NPI | 1922615616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 28410) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 28410) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS PAPA-03IX09) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MS 904282) | |
| Enumeration Date | 2020-09-26 |
| Last Update Date | 2024-01-10 |