| NPI | 1851842579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN639688) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 115066) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2020-08-31 |