| NPI | 1114276805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 269181) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV CRNA000489) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2022-05-19 |