| NPI | 1962532887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-106988) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: AL 1-16988) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2024-08-07 |