| NPI | 1003225566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MI 4703084481) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: AR L046364) |
| 101Y00000X Counselor | |
| Enumeration Date | 2014-08-09 |
| Last Update Date | 2017-04-18 |