| NPI | 1609945336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 076164) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 180189) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2018-10-09 |