| NPI | 1700833100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704198561) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D175496) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2024-02-27 |