| NPI | 1972194561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71010794A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28164648A) |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2021-03-29 |