| NPI | 1194268656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704292833) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704292833) |
| 163W00000X Registered Nurse (Licence: FL 9382735) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 245396) | |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2021-04-06 |