| NPI | 1083651665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA462) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID N29640) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2019-03-11 |