| NPI | 1932272796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704255455) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN552951) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2018-12-12 |