| NPI | 1598815078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3005233) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 122854) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2022-07-21 |