| NPI | 1760499776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024174371) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R171560) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2021-03-26 |