| NPI | 1275042251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60824089) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MT 48568) |
| 163W00000X Registered Nurse (Licence: PA 670677) | |
| 163W00000X Registered Nurse (Licence: WV 93880) | |
| 163W00000X Registered Nurse (Licence: OH 421116) | |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2018-06-25 |