| NPI | 1619256690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R865752) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 102392) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2025-02-07 |