| NPI | 1164565347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801087573) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MI 4704145402) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2007-07-08 |