| NPI | 1922530062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 59106) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA-01479) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2018-07-30 |