| NPI | 1104132356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 299836) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201260043CRNA) |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2024-02-08 |