| NPI | 1578603718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 035818) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 074797) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2018-10-11 |