| NPI | 1679626972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 278417) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R28174) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2024-03-07 |