| NPI | 1447670096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN248034L) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR10172000) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2014-04-22 |