| NPI | 1992962187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 079673) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 143024) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2018-08-21 |