| NPI | 1073921060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 272751) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704215594) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2018-11-16 |