| NPI | 1215490974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2019017170) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MO 2012017524) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2019-05-29 |