| NPI | 1124728175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MA LN100403) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CT 44404) |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2023-03-08 |