| NPI | 1255493953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 4359) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 158511) |
| Enumeration Date | 2006-12-16 |
| Last Update Date | 2023-05-24 |