| NPI | 1053031534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704311477) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704311477) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.0020634) | |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2025-01-27 |