| NPI | 1356407852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 22810) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 001719) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2020-11-11 |