| NPI | 1871573014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP05050) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C01511) |
| Enumeration Date | 2006-01-21 |
| Last Update Date | 2017-08-28 |