| NPI | 1528832342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN730571) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR21971800) |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2023-11-13 |