| NPI | 1568428282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024189437) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 070192) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2024-04-22 |