| NPI | 1326366915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MD T20100434) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN539146) |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2010-05-07 |