| NPI | 1124540208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP09389) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 102193) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2024-11-07 |