| NPI | 1295928919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 78237) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 122502) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2020-02-04 |