| NPI | 1962640136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN553098) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L10034592) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L60A00565) | |
| 367H00000X Anesthesiologist Assistant (Licence: DE L60A00565) | |
| Enumeration Date | 2009-01-27 |
| Last Update Date | 2019-01-07 |