| NPI | 1619975455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C001215) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 621415) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2024-10-30 |