| NPI | 1548824790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK M113074) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 81480) |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2019-05-20 |