| NPI | 1639287105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000552) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD R032646) |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2022-05-12 |