| NPI | 1073843710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60215327) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 083352) |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2023-04-11 |