| NPI | 1194273540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 42034.1850) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28240666A) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209-014807) | |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2019-01-29 |