| NPI | 1194218164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024176359) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 122361) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2018-11-05 |