| NPI | 1164810727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D121535) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 121535) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2019-07-16 |