| NPI | 1376509653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024-157969) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001-157969) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2020-12-01 |