| NPI | 1184096620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 53419) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 118966) |
| 163W00000X Registered Nurse (Licence: OK 118966) | |
| 163W00000X Registered Nurse (Licence: ID 53419) | |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2016-07-20 |