| NPI | 1972933133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L6-0A10866) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN583605) |
| Enumeration Date | 2013-11-25 |
| Last Update Date | 2022-02-01 |