| NPI | 1972757771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 21900) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 5588901-4406) |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2018-09-19 |