| NPI | 1356728018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704313699) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-140350) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2016-04-11 |