| NPI | 1396211231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 244941) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000193980) |
| Enumeration Date | 2018-10-18 |
| Last Update Date | 2019-03-27 |