| NPI | 1922480896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9441386) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 720891) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2017-10-25 |