| NPI | 1174808638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS A810475) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MS R877664) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3007275) | |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2016-08-23 |