| NPI | 1467842898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2020038995) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 653713) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP128147) | |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2021-06-10 |