| NPI | 1205870326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 101047) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 0158620) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2022-01-13 |