| NPI | 1699872341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 69143) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 104175) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2024-04-25 |