| NPI | 1124419882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 19390) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 203921) |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2016-04-26 |