| NPI | 1265817779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 110038) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2010003635) |
| Enumeration Date | 2015-07-26 |
| Last Update Date | 2016-02-28 |