| NPI | 1932589769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 108807) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 236265) |
| Enumeration Date | 2015-06-07 |
| Last Update Date | 2015-11-02 |