| NPI | 1366484495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 99928) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0004297-CRNA) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2025-03-14 |