| NPI | 1922456599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 22713) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704280484) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704280484) | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2019-06-18 |