| NPI | 1457731549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704284110) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9354815) |
| 163W00000X Registered Nurse (Licence: MI 4704284110) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2017-11-14 |