| NPI | 1336938422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA2000X Registered Nurse, Administrator (Licence: MA RN2295220) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2295220) |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2025-05-05 |