| NPI | 1487657904 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP01969)  | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN030558)  | 
| Enumeration Date | 2005-05-30 | 
| Last Update Date | 2022-12-15 |