| NPI | 1942314117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024181129) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001300998) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 105555) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2021-10-06 |