| NPI | 1366535973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR0000397) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD NP6356) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R24634) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-12-28 |