| NPI | 1477033744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R38667) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN813016) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NV CRNA813016) | |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2019-09-18 |