| NPI | 1629481981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C003026) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR C003026) |
| 163W00000X Registered Nurse (Licence: AR R085381) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2022-01-06 |