| NPI | 1760831754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28228678A) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 24275) |
| 163W00000X Registered Nurse (Licence: IN 28228678A) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2018-06-15 |