| NPI | 1225472251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 19051) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA 091743) |
| Enumeration Date | 2013-04-21 |
| Last Update Date | 2021-11-02 |