| NPI | 1205106523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C002963) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R077091) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2024036785) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 810543) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 16514) | |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2024-10-02 |