| NPI | 1962966135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0994681) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: CO 1659154) |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2019-09-27 |