| NPI | 1649524620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA898A) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 31405.1221) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2020-12-30 |