| NPI | 1801956792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R26525) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1222) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2024-12-10 |