| NPI | 1932600970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2208) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SD R035316) |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2019-07-30 |