| NPI | 1528050713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 38796) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55094) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2025-08-20 |