| NPI | 1386914760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 0991212) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN569254) |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2022-07-21 |