| NPI | 1194437194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA 228846) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 228846) |
| Enumeration Date | 2022-12-21 |
| Last Update Date | 2024-02-24 |