| NPI | 1558716894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704273227) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MI 3201011305) |
| Enumeration Date | 2016-04-24 |
| Last Update Date | 2018-07-05 |