| NPI | 1184630105 |
|---|---|
| Other Name | N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 087994-23) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NH 087994-21) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 110008656) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NH EL08510) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2022-05-11 |