| NPI | 1154907624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 25062) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC TBD) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2022-01-27 |