| NPI | 1508121666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NC 217745) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 091153) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2021-03-17 |