| NPI | 1821098930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 20635) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 071173) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 003790) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2021-12-21 |