| NPI | 1902136435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024172891) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN612087) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 107866) | |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2019-07-29 |