| NPI | 1952670846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 16298) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3007262) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2025-04-29 |