| NPI | 1992728216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 396) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC R34435) |
| 163W00000X Registered Nurse (Licence: SC 34435) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-11-11 |