| NPI | 1093002289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP06538) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 89919-6538) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2021-10-21 |