| NPI | 1982880282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 2271651) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 643942) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2019-03-26 |