| NPI | 1780724419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 63318) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID N-26821) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WA MB2468470) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2023-01-31 |