| NPI | 1992489579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71014180A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28225056A) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2023-09-05 |