| NPI | 1164773685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D152469) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 1234) |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2020-03-31 |