| NPI | 1780915215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 100773) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D074395) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000345) | |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2017-11-07 |