| NPI | 1669436119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 146) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC R70934) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2023-08-17 |