| NPI | 1003365974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 6901) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R232825) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024182459) | |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2024-03-08 |