| NPI | 1265798813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 4704419970) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: MI 5303049912) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2025-05-17 |