| NPI | 1629443742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 4704346654) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MI 4703115678) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2018-12-19 |