| NPI | 1659606853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 4704179831) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK 8865) |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2009-10-06 |