| NPI | 1124690201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2023008885) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557910) |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2023-03-17 |