| NPI | 1396231833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901594) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 203743) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 24769) | |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2019-11-07 |