| NPI | 1629360029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: MA 217716) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: MD R156749) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2023-08-07 |