| NPI | 1215563036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704314144) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 4704314144) |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2023-06-12 |