| NPI | 1821115593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024168105) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 127178) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2017-10-03 |