| NPI | 1508129511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024173043) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC001041) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2024-05-02 |