| NPI | 1497773931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 154123) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D158510) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2022-11-04 |