| NPI | 1053417774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IN 28153037A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD429594) |
| 207Q00000X Family Medicine (Licence: KY 41334) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2023-01-13 |