| NPI | 1164734810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN557755) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY N25139) |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2026-01-30 |