| NPI | 1912277872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024169867) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 104618) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC002180) | |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2018-03-17 |