| NPI | 1205580313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV 848576) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 162603) |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2024-01-02 |