| NPI | 1598007759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024170670) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001209401) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2021-07-28 |