| NPI | 1801870480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28087122A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 28087122) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2014-10-01 |