| NPI | 1134631187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7114) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 23660) |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2023-05-18 |