| NPI | 1659302412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN352434L) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L60A00387) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2018-08-28 |