| NPI | 1992249395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 114358) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 291684) |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2017-01-20 |