| NPI | 1811357940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024173646) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 233809) |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2016-09-13 |