| NPI | 1164405684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 1354) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC R83960) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2022-03-02 |