| NPI | 1053075226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61379372) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 137294) |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2024-03-21 |