| NPI | 1013270511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704291695) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 772359) |
| 163W00000X Registered Nurse (Licence: MI 4704291695) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2014-09-11 |