| NPI | 1639418668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA TLRN061071) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: DC RN1035275) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024170641) | |
| Enumeration Date | 2013-02-12 |
| Last Update Date | 2021-10-25 |