| NPI | 1326261355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP04868) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN100965) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2023-01-06 |