| NPI | 1063709335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP06485) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN117613) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2023-04-04 |