| NPI | 1447585658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN2262126) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NH 014846-22) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2009-10-05 |