| NPI | 1194083170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN517275L) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9281549) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2012-04-27 |