| NPI | 1235596545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 20699) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 20682) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2023-12-12 |