| NPI | 1245794874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: MA RN2309588) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MA RN2309588) |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2019-01-28 |