| NPI | 1215210430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN 311621L) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC RN 88214R) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2011-09-23 |