| NPI | 1508393851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN2311503) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 101758) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2017-05-17 |