| NPI | 1003976135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA APO3632) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN065495) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2021-04-05 |