| NPI | 1750770327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D151036) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 843189) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2019-08-26 |