| NPI | 1558662478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D139273) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.014002) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN620237) | |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2021-06-22 |