| NPI | 1124557343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704277960) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MI 3201009728) |
| 163W00000X Registered Nurse (Licence: MI 4704277960) | |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2018-12-03 |