| NPI | 1164504403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 384) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 12213) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2023-09-20 |