| NPI | 1003129875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024191880) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9235700) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2024-12-16 |