| NPI | 1255617080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC0400X Registered Nurse, Case Management (Licence: MI 4704280192) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: MI 4704280192) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2018-11-19 |