| NPI | 1760476840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 245247) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 2840A) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2018-03-17 |