| NPI | 1801082516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 53058) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 152022) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2018-08-22 |