| NPI | 1871884742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 17516) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 100263) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2020-11-09 |