| NPI | 1063475283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 10399) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 21451) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2023-12-08 |