| NPI | 1033757992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2019046044) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 30092) |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2023-01-09 |