| NPI | 1083203467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 29069) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 131138) |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2022-03-25 |