| NPI | 1205839727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 12004) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 851973) |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2025-03-17 |