| NPI | 1770501892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101306) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 68833 030) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 1873) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-03-02 |