| NPI | 1124400601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 24600) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R096488) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2021-01-22 |