| NPI | 1841735552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: ID 42925) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 114339) |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2017-01-04 |