| NPI | 1679555064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C000919) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R020284) |
| Enumeration Date | 2005-11-19 |
| Last Update Date | 2020-04-15 |