| NPI | 1013395706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 175567) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX in process) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2022-01-03 |