| NPI | 1972760304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN742631) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 138092) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2021-06-08 |