| NPI | 1366971533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: DC RN1026396) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2276965) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2019-07-03 |