| NPI | 1104825116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C003278) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK R0083727) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP128983) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 596812) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.17071) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2022-03-10 |