| NPI | 1184964470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN2282066) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: MA A) |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2022-07-21 |