| NPI | 1710878152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MA LN1O2218) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MA LN102218) |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2025-07-14 |