| NPI | 1265203988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA TLRN074157) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 114409) |
| Enumeration Date | 2024-01-11 |
| Last Update Date | 2024-01-11 |