| NPI | 1194998153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 18725) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 5536A) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2021-01-26 |