| NPI | 1700188224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 62520) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC rn1013297) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024169270) | |
| Enumeration Date | 2010-12-04 |
| Last Update Date | 2024-03-29 |