| NPI | 1063702769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61477887) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-876A) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101155) | |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2024-01-12 |