| NPI | 1447617659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP2201X Registered Nurse, Ambulatory Care (Licence: MA 2291000) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: MA 2291000) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2016-02-09 |