| NPI | 1063528743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA00844) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 28116325) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2024-05-13 |