| NPI | 1487984399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 083102) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 172600) |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2023-05-30 |