| NPI | 1619245768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP06702) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R889935) |
| Enumeration Date | 2011-12-05 |
| Last Update Date | 2022-07-21 |