| 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 |