| NPI | 1174503916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024179730) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 77560) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2021-09-27 |