| NPI | 1437557667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN580935) |
| Additional Taxonomies | 163WM0705X Registered Nurse Medical-Surgical (Licence: FL RN9180687) |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2014-12-22 |