| NPI | 1932753878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 62583) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: ID 48308) |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2019-09-20 |