| NPI | 1386887263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 004706) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 551730) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3783) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2018-09-14 |