| NPI | 1942520101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MA LN65112) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: MA LN65112) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2022-01-12 |