| NPI | 1316424930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA 125013) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2012005644) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2018-12-29 |