| NPI | 1376832139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 4015) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 004623) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2018-09-06 |