| NPI | 1033860747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN720755) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR22599500) |
| Enumeration Date | 2022-01-13 |
| Last Update Date | 2022-01-15 |