| NPI | 1568143774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: MA RN2360844) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: MA PT13385) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2023-07-31 |