| NPI | 1407278054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9413381) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-108160) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3009357) | |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2017-04-04 |