| NPI | 1306930649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 053814) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 80075) |
| 163W00000X Registered Nurse (Licence: NC 161862) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-12-07 |