| NPI | 1487809505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024172814) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 28136) |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2023-02-02 |