| NPI | 1053101295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN9639169) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9639169) |
| 163WC0400X Registered Nurse, Case Management (Licence: MA RN9639169) | |
| Enumeration Date | 2025-05-10 |
| Last Update Date | 2025-05-10 |