| NPI | 1740518653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 259581) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 26660) |
| Enumeration Date | 2009-12-04 |
| Last Update Date | 2023-01-12 |