| NPI | 1881707834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D143569) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 100900) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2019-12-17 |