| NPI | 1477017275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001105) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN686691) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.018963) | |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2022-08-02 |