| NPI | 1982244075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: MA RN2323890) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: MA RN2323890) |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2020-01-07 |