| NPI | 1508035585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK R0091163) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD R032552) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2020-11-11 |