| NPI | 1881796571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 864936) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 25674) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2025-03-04 |