| NPI | 1740391440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001831) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 124387) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-10-20 |