| NPI | 1790968634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-713) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 45675) |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2023-10-02 |