Individual
ERIC OCHIENG OKOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1916 VICKERY RD, PORTAGE, MI 49002-7610
(425) 289-8514
Mailing address
1916 VICKERY RD, PORTAGE, MI 49002-7610
(425) 289-8514
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703103818
MI
Other
Enumeration date
05/26/2010
Last updated
05/26/2010
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