| NPI | 1962843755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 19562) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 93677) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2020-06-01 |