| NPI | 1962036715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71009892A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28222838A) |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2020-03-10 |