| NPI | 1790210615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024174880) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001271646) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2017-06-05 |