| NPI | 1881924199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 53508) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO Pending) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2020-02-11 |