| NPI | 1720233745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD r145444) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R145444) |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2020-04-17 |