| NPI | 1700248002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 53510) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID N39889) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2016-06-23 |