| NPI | 1568609378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 27644) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 81429) |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2024-03-15 |