| NPI | 1093249070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DE L1-0030377) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN541592) |
| 163W00000X Registered Nurse (Licence: NJ 26NR17203600) | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2017-04-17 |