| NPI | 1750897534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 120518) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 71435) |
| Enumeration Date | 2017-12-16 |
| Last Update Date | 2018-08-23 |