| NPI | 1285870253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN570026) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 149664) |
| Enumeration Date | 2008-12-23 |
| Last Update Date | 2019-11-19 |