| 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 |