| NPI | 1063165835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 3006) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 12064) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 194157) | |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2024-09-12 |