| NPI | 1821560996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 244546-30) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 118986) |
| Enumeration Date | 2018-12-29 |
| Last Update Date | 2019-01-29 |