| NPI | 1780791210 |
|---|---|
| Doing Business As | |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 76954-030) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 569-033) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2023-11-28 |