| NPI | 1659540383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101019) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 101019) |
| 163W00000X Registered Nurse (Licence: NE 66977) | |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2018-10-02 |