| NPI | 1235547936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN215810) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ME RN62641) |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2014-07-25 |