| NPI | 1871982173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9464205) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-121895) |
| Enumeration Date | 2015-01-10 |
| Last Update Date | 2021-01-18 |