| NPI | 1649761909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024177281) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN239945) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2019-03-01 |