| NPI | 1316455140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 23984) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MA RN2289867) |
| Enumeration Date | 2018-01-15 |
| Last Update Date | 2020-08-26 |