| NPI | 1023412426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024186550) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 174037) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2023-03-09 |