| NPI | 1144743485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704284890) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 279425) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2018-12-13 |