| NPI | 1265886808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5436) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 215197) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 110989) | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2021-05-13 |