| NPI | 1992141816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71004504A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28168892A) |
| Enumeration Date | 2013-05-19 |
| Last Update Date | 2022-10-03 |