| NPI | 1083780142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN0509030) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 092978-23) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2025-05-05 |