| NPI | 1104813591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 10380) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN RN134650) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OK R0090672) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 1115186) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2023-10-09 |