| NPI | 1760854467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN332613L) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: PA RN332613L) |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2015-10-21 |