| NPI | 1871595512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C002946) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R105201) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2019-12-02 |