| NPI | 1780628180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 11099) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 70304) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2017-04-04 |