| NPI | 1205801446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C001144) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R62890) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 9944) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2020-04-06 |