| NPI | 1053760595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901587) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 891961) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 22207) | |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2019-10-25 |