| NPI | 1548656564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5220) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 245932) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024175283) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 106615) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2021-06-24 |