| NPI | 1649566936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 5047072-8901) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO CRA-1000040) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2021-10-01 |