| NPI | 1912120551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-709A) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 22689) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2024-04-29 |