| NPI | 1700936267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 4252) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 193618) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 193618) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2022-01-27 |