| NPI | 1205073996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 22156) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R851201) |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2017-03-14 |