| NPI | 1780609800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 14302) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-079490) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2003022119) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2022-03-16 |