| NPI | 1760704027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C002812) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C02812) |
| 163W00000X Registered Nurse (Licence: AR R66955) | |
| Enumeration Date | 2010-02-26 |
| Last Update Date | 2024-05-10 |