| NPI | 1295108975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: MA RN2302096) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: CT E55494) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2015-11-04 |