| NPI | 1811907959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 1863) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 074005) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 036848) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2021-04-13 |