| NPI | 1508162330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 259329) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R160790) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R160790) | |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2023-01-26 |