| NPI | 1124110150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9296902) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA 097420) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2022-05-19 |