| NPI | 1932538683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71004693A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209027989) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2023-11-29 |