| NPI | 1689926164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 3462) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 257443) |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2025-06-30 |