| NPI | 1619343639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 232507) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5245) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2018-03-17 |