| NPI | 1881042356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101504) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D151605) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024173582) | |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2019-06-25 |