| NPI | 1891059069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 91093) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 216563) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2017-05-19 |