| NPI | 1700467974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MI 4703119474) |
| Additional Taxonomies | 2472R0900X Technician, Other, Renal Dialysis |
| 164X00000X Licensed Vocational Nurse (Licence: MI 4703119474) | |
| 126800000X Dental Assistant | |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2021-04-19 |