| NPI | 1235561960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 20812) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R870773) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2016-01-28 |