| NPI | 1417373788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC002743) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 23203) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5827) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 102534) | |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2022-06-23 |