| NPI | 1790095537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 085579) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 211027) |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2022-03-01 |