| NPI | 1356512503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP04954) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN084102) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 16132) | |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2025-01-31 |