| NPI | 1912220997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024179099) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 219307) |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2022-08-07 |