| NPI | 1700180338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA 623024) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 629747) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2011-09-22 |