| NPI | 1558838516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 25277) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: TN 20064) |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2020-10-15 |