| NPI | 1861458648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 306) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 181130) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 181130) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2022-02-01 |