| NPI | 1063077949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK M133111) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2011021502) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2019-11-18 |