| NPI | 1245398296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 303945) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 465920) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2019-01-23 |