| NPI | 1770539132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 9482) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 78003) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2022-08-10 |