| NPI | 1326464090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101243) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA 126688) |
| Enumeration Date | 2014-03-05 |
| Last Update Date | 2020-08-04 |