| NPI | 1518324243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 108915) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 19978) |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2016-01-27 |