| NPI | 1861722423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 20121) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704223939) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704223939) | |
| Enumeration Date | 2010-01-05 |
| Last Update Date | 2017-03-27 |