| NPI | 1891146833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 110910) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 255689) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2016-07-19 |