| NPI | 1518215136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 17716) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R077286) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2012014458) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2018-11-08 |