| NPI | 1588995435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-766) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID Temp 21060) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2023-10-02 |