| NPI | 1811534381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN2265548) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NH 067644-21) |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2019-12-04 |