| NPI | 1215950530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 0991460) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK R0049391) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-01-04 |