| NPI | 1750317657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024167972) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 24167972) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 187161) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2024-03-13 |