| NPI | 1922519479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2223) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 74138) |
| 163W00000X Registered Nurse (Licence: MN 2466557) | |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2018-08-13 |