| NPI | 1225545262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 211715-3) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 222424) |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2021-02-26 |