| NPI | 1316481625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3010948) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 416443) |
| 163W00000X Registered Nurse (Licence: IL 041.446613) | |
| 163W00000X Registered Nurse (Licence: TN 199315) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.015519) | |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2022-03-31 |