| NPI | 1811539380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN785776) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 3284535) |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2026-07-23 |