| NPI | 1316784507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704359447) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704359447) |
| Enumeration Date | 2024-07-13 |
| Last Update Date | 2025-12-17 |