| NPI | 1396761946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704178079) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH RN263873) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2012-01-13 |