| NPI | 1184684425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024184195) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 3119372) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2022-10-21 |