| NPI | 1154802064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 33625) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 246442) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2023-06-19 |