| NPI | 1134115702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC000499) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L6-0A00476) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2023-09-28 |