| NPI | 1053381160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-040035) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 410) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2022-09-22 |