| NPI | 1558624908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 4908) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D162896) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2021-12-20 |