| NPI | 1063565802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R27402) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: ND R27402) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1466) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2024-09-03 |