| NPI | 1497177760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024171442) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 100110) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000481) | |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2016-06-29 |