| NPI | 1912441692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 22113) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 292165) |
| 163W00000X Registered Nurse (Licence: VA 0001253285) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 112751) | |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2018-11-12 |