| NPI | 1740210061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA APO4029) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN089353) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C02817) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2021-07-07 |