| NPI | 1518134451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2005035514) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 0000472) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2018-09-28 |