| NPI | 1770727158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201060008) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3851) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2021-06-10 |