| NPI | 1144610882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024173312) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA143055) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2021-02-28 |