| NPI | 1124612957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024185538) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R226764) |
| Enumeration Date | 2021-02-23 |
| Last Update Date | 2022-11-18 |