| NPI | 1992803639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C001454) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R043287) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-03-30 |