| NPI | 1982485926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 28209390A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 71014507A) |
| Enumeration Date | 2023-10-06 |
| Last Update Date | 2025-06-05 |