| NPI | 1912017070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000660) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD R029305) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R49054) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-12-28 |