| NPI | 1649500687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA2000X Registered Nurse, Administrator (Licence: MI 4704180471) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: MI 4704180471) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2010-01-13 |