| NPI | 1043603764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704282268) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 47404282268) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209023353) | |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2021-07-01 |