| NPI | 1871927608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 12032) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 196885-30) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2022-07-14 |