| NPI | 1346327939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IN 28163818A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06002156A) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |