| NPI | 1790153831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MI 4704352012) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: MI 5303001592) |
| 246RP1900X Technician, Pathology, Phlebotomy | |
| Enumeration Date | 2015-09-06 |
| Last Update Date | 2021-01-25 |