| NPI | 1972815314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D150393) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 169318-30) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 4115-33) | |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2020-11-18 |