NPI | 1720351521 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN545560) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 448986) |
163W00000X Registered Nurse (Licence: OH RN236804) | |
Enumeration Date | 2012-02-10 |
Last Update Date | 2012-02-10 |