| NPI | 1194368621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557915) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 57965) |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2023-08-17 |