| NPI | 1164105433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 223442) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002261) |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2024-10-06 |