| NPI | 1790043735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 5008) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 080485) |
| 367H00000X Anesthesiologist Assistant | |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2020-12-21 |