| NPI | 1689005753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN566630) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9372714) |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2013-11-27 |