| NPI | 1497085211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 228822) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1104317) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN700247) | |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2023-01-31 |