| NPI | 1083079990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L6-0A00749) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN610176) |
| 163W00000X Registered Nurse (Licence: DE L1-0047862) | |
| Enumeration Date | 2015-12-18 |
| Last Update Date | 2020-04-22 |