| NPI | 1194767020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3014095) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 25170) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-031943) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-05-05 |