| NPI | 1407238728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3009482) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 0092296) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2021-06-09 |