| NPI | 1366789570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C002939) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R079036) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2020-06-25 |