| NPI | 1710044391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C002649) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 908397) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901576) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2024-07-09 |