| NPI | 1467626309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 1007) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 1007) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2020-10-13 |