| NPI | 1528048626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R798682) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 23133) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2018-05-23 |