| NPI | 1649461716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 0998027) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60905089) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN532761) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2022-10-11 |