| NPI | 1871303115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN796255) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 202005995RN) |
| Enumeration Date | 2025-01-09 |
| Last Update Date | 2025-01-09 |