| NPI | 1477901023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2016019080) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2010000185) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2019-07-08 |