| NPI | 1083994685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 22205) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK R87903) |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2017-05-01 |