| NPI | 1932560240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024190536) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71006025A) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2024-10-25 |