| NPI | 1780777698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 552832) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: HI APRN-772) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3145) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2021-11-29 |