| NPI | 1982660957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024176880) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 10886) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2019-10-28 |