| NPI | 1114291051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 19789) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 205653) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 088676) | |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2022-01-05 |