| NPI | 1922398833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP06517) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN110237) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2017-09-21 |