| NPI | 1841689601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN690450) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 173771) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 20265) | |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2017-02-14 |