| NPI | 1649725516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 565952) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 240676) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2016-08-22 |