| NPI | 1952587537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024168857) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 132261-030) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 077953) | |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2023-09-03 |