| NPI | 1144765389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D119639) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 119639) |
| 163W00000X Registered Nurse (Licence: SD R048350) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000932) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101388) | |
| Enumeration Date | 2016-12-26 |
| Last Update Date | 2017-05-03 |