| NPI | 1528243730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: ME R043683) |
| Additional Taxonomies | 163WH0200X Registered Nurse Home Health (Licence: ME R043683) |
| 163WM1400X Registered Nurse Nurse Massage Therapist (NMT) (Licence: ME R043683) | |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2008-01-07 |