| NPI | 1760564363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 110507) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024166931) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN205132) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2016-07-18 |