| NPI | 1649299348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA00749) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 113575) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-10-14 |