| NPI | 1932654175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN2284924) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 110099) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2016-08-17 |