| NPI | 1932613858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 120603) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA 618659) |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2018-01-17 |