| NPI | 1760868004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 27612) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R871159) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2020-09-08 |