| NPI | 1790053569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2012006261) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-115596) |
| 163W00000X Registered Nurse (Licence: MO 2011040586) | |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2018-02-19 |