| NPI | 1124321146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704255510) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704255510) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2017-12-20 |