| NPI | 1356884159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704289695) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC 227721) |
| 163W00000X Registered Nurse (Licence: MI 4704289695) | |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2018-04-23 |