| NPI | 1962853028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 47-04-192152) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: MI 47-04-192152) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2016-06-29 |