| NPI | 1679970057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R199591) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R199591) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2017-01-12 |