| NPI | 1275801870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 0940) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 203222) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 100091) | |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2018-09-24 |