| NPI | 1720252430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 2099) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 181529) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 079666) | |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2023-09-07 |