| NPI | 1316108186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN646665) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 079772) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2020-08-31 |