| NPI | 1922471705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VT 101.0117609) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: PA RN623880) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2016-02-03 |