| NPI | 1376827022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 23450) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 088192) |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2020-01-09 |