| NPI | 1407836521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA 127743) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: MA 127743) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2007-07-08 |