| NPI | 1245564673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10048903) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 2262934) |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2025-10-16 |