| NPI | 1013088194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9397267) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 110691) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2024-11-04 |