| NPI | 1578600854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 070365) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 191041) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2018-11-14 |