| NPI | 1245760396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704281273) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9370346) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2023-01-27 |