| NPI | 1932565561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71006136A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28185825A) |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2017-08-03 |