| NPI | 1912256132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R878052) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557119) |
| Enumeration Date | 2012-09-04 |
| Last Update Date | 2017-06-16 |