| NPI | 1477984987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704303456) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704303456) |
| 163W00000X Registered Nurse (Licence: TN 162905) | |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2014-02-16 |