| NPI | 1558809921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2101) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 219236-30) |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2017-10-17 |