| NPI | 1083978043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 91107) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 191860) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2023-11-16 |