| NPI | 1205390226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 29212) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024177198) |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2021-07-20 |