| NPI | 1629309604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024171707) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R188858) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2018-01-30 |