| NPI | 1821451469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024173592) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 249139) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2016-08-08 |