| NPI | 1376879643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DE L1-0017957) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN353787L) |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2009-10-21 |