| NPI | 1134750334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024178743) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001250924) |
| Enumeration Date | 2020-01-28 |
| Last Update Date | 2020-01-28 |