| NPI | 1871516484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 138117) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D176707) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-11-20 |