| NPI | 1013640598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 12029) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 13029-33) |
| Enumeration Date | 2022-07-02 |
| Last Update Date | 2022-07-26 |