| NPI | 1962828368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704237177) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH RC268385) |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2015-07-29 |