| NPI | 1477860419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1073706) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 252587) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ME AA103018) | |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2026-09-10 |