| NPI | 1942923198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71013109A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28200542A) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2024-04-18 |