| NPI | 1194160093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101404) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 64178) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2017-11-16 |