| NPI | 1528681657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9509428) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-148410) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-148410) | |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2020-07-06 |