| NPI | 1760420558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 372) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 35223) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2024-03-11 |