| NPI | 1174591911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 100341) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D091669) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2019-06-26 |