| NPI | 1255721841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 302903) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN244092L) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2015-02-03 |