| NPI | 1003847104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 101158) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID N-30039) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2019-04-23 |