| NPI | 1679521744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV CRNA000199) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 193069-4406) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN575952) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2023-06-01 |