| NPI | 1093257768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024174556) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001258580) |
| Enumeration Date | 2016-11-13 |
| Last Update Date | 2017-03-31 |