| NPI | 1598061053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024169251) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R191518) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA4420) | |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2015-03-23 |