| NPI | 1326408964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP08916) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN132642) |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2019-01-25 |