| NPI | 1598272643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101474) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 115221) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D115221) | |
| Enumeration Date | 2018-01-10 |
| Last Update Date | 2020-08-19 |