| NPI | 1811976335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1134) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA 100646) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2020-09-17 |