| NPI | 1689849713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA 276316) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MA 276316) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2008-04-29 |