| NPI | 1528404704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 322) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 265185) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 111111111) | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2024-01-02 |