| NPI | 1861434425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ crna283860) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 656711) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 041709) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2022-11-18 |