| NPI | 1578936076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 6680-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 162127-30) |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2018-08-27 |