| NPI | 1477595411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201260021) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 46012) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2018-03-17 |