| NPI | 1639643422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 25308) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 25308) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 203117) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 106587) | |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2023-05-10 |