| NPI | 1902294366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN244914) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 317661) |
| 163W00000X Registered Nurse (Licence: KY 1131140) | |
| 163W00000X Registered Nurse (Licence: IN 28213083A) | |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2015-02-27 |