| NPI | 1982880209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 2092) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 13023) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 78151) | |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2020-03-13 |