| NPI | 1326593906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC002481) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 0000590-C) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2019-01-05 |