| NPI | 1619143633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 25656) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN529454L) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.020082) | |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2022-09-15 |