| NPI | 1891201547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 1035533) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL 9415723) |
| 163W00000X Registered Nurse (Licence: WI 24052130) | |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2021-03-19 |