| NPI | 1609962612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA-01145) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 037524) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2017-10-24 |