| NPI | 1023672318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 61748) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 83133) |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2020-11-20 |