| NPI | 1134371503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 200860046CRNA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 101170) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2025-02-17 |