| NPI | 1023167046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 3617) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 146939) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2021-05-27 |