| NPI | 1356863625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 0996084) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN NA) |
| Enumeration Date | 2017-07-08 |
| Last Update Date | 2021-03-09 |