| NPI | 1881833655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704234700) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 4704234700) |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2009-02-18 |