| NPI | 1871917294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R880851) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 2723) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2016-03-10 |