| NPI | 1073888731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 4704193798) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: MI 4704193798) |
| 163WH0200X Registered Nurse Home Health (Licence: MI 4704193798) | |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2012-03-14 |