| NPI | 1093138141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 244761) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 680996-1) |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2021-01-12 |