| NPI | 1912985755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 59928) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM R48739) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA00752) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95000124) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2023-10-06 |