| NPI | 1952070799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 28226050A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71011659A) |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2025-10-02 |