| NPI | 1134579147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 005454) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 244227) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2021-07-01 |