| NPI | 1649516584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN576200) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R227805) |
| Enumeration Date | 2012-12-21 |
| Last Update Date | 2022-07-21 |