| NPI | 1477997708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D108429) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 68002) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101219) | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2024-02-09 |