| NPI | 1407268931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 269055) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 653057) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP128069) | |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2023-06-29 |