| NPI | 1669889994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 4704284035) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MI 4704284035) |
| 163WG0600X Registered Nurse, Gerontology (Licence: MI 4704284035) | |
| 163WH0200X Registered Nurse, Home Health (Licence: MI 4704284035) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MI 4704284035) | |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2014-07-18 |