| NPI | 1982061701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71006122A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28202205A) |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2019-08-14 |