| NPI | 1417490962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 21030) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 217411) |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2021-11-12 |