| NPI | 1780191338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024175780) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 119176) |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2018-02-01 |