| NPI | 1275593840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101471) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA 098195) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2022-09-14 |