| NPI | 1861472136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2001000429) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 39365) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2025-12-10 |