| NPI | 1457803983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D127888) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 218994) |
| 163W00000X Registered Nurse (Licence: IA 127888) | |
| 163W00000X Registered Nurse (Licence: MN 220185-2) | |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2020-06-15 |