| NPI | 1699648923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MA LN89884) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CT 11.038384) |
| Enumeration Date | 2025-09-24 |
| Last Update Date | 2025-09-24 |