| NPI | 1356326904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10016782) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN10005202) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61494483W) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 33832) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2025-02-04 |