| NPI | 1952745499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28221931A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R079312) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2013012833) | |
| Enumeration Date | 2013-04-27 |
| Last Update Date | 2018-10-22 |