| NPI | 1336541275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9265963) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 110249) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2020-03-05 |