| NPI | 1952849218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71007050A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 041-452409) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2023-11-10 |