| NPI | 1245698083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024173590) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001225000) |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2020-03-09 |