| NPI | 1215401948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 66709) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0001251248) |
| Enumeration Date | 2019-01-16 |
| Last Update Date | 2022-03-10 |