| NPI | 1518917574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-497A) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 266931) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1055445) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2023-11-28 |