| NPI | 1992807895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024174448) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 666267) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2018-06-08 |