| NPI | 1861645459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0116036102) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 211168) |
| 164W00000X Licensed Practical Nurse (Licence: WI 309314-031) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2024-09-10 |