| NPI | 1801345566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704295628) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: MI 4704295628) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2018-07-30 |