| NPI | 1619188604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901434) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 093642) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 779617) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2023-01-30 |