| NPI | 1598757569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2018039617) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000126841) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2021-09-01 |