| NPI | 1033571724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5421) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 231737) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2020-12-29 |