| NPI | 1003220633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2014017971) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2008020244) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2014-07-02 |