| NPI | 1487042651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C003067) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R088090) |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2020-04-14 |