| NPI | 1790720274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024186002) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM R56419) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2024-10-07 |