| NPI | 1275948929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2017002569) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 84042) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2018-04-25 |