| NPI | 1669942074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101525) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 111032) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D154760) | |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2019-06-13 |