| NPI | 1386927838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 32014.1246) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 174033) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2021-09-16 |