| NPI | 1194811067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 177154) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-10-14 |