| NPI | 1174505606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 73154) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 073154) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2025-02-28 |