| NPI | 1063608982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: RI RN42098) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 274754) |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2007-09-25 |