| NPI | 1205489127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN647327) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L6-0A00808) |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2024-06-10 |