| NPI | 1376802181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 5053) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 082242) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2018-03-17 |