| NPI | 1740693621 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN2266107) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NH 058664-21) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2014-06-09 |