| NPI | 1174919005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101297) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 62972) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2016-05-06 |