| NPI | 1356588412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3595) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 156931) |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2017-09-25 |