| NPI | 1497269054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC003629) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001257490) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024175838) | |
| Enumeration Date | 2017-11-18 |
| Last Update Date | 2021-07-07 |