| NPI | 1275167595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 128042) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2010019408) |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2020-07-31 |