| NPI | 1326041807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 200860053CRNA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT RN28361) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2021-07-28 |