| NPI | 1386064657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C003029) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R078206) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2021-08-23 |