| NPI | 1760935456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 153134) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 000000) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2020-12-28 |