| NPI | 1861725467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3843) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 97599) |
| 163W00000X Registered Nurse (Licence: CA 651370) | |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2022-01-03 |