| NPI | 1922102045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2021013062) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA RN 480439 NA 1911) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2023-11-03 |