| NPI | 1295108611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 80022) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 193075) |
| Enumeration Date | 2015-11-06 |
| Last Update Date | 2018-03-17 |