| NPI | 1023303765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP06540) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 109718) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2022-12-28 |