| NPI | 1861731358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000328) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704266767) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5407) | |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2016-06-21 |