| NPI | 1710412580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 7293) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 085097) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2019-10-10 |